To constrain or not to constrain, and other stories of intensive upper extremity training for children with unilateral cerebral palsy. Impaired hand function is among the most functionally disabling symptoms of hemiplegia in children (also known as unilateral cerebral palsy). Evidence-based treatment approaches are generally lacking. However, recent approaches providing intensive upper extremity training appear promising. This review describes two such approaches, constraint-induced movement therapy (CIMT) and bimanual training (hand-arm bimanual intensive therapy, HABIT). Findings are summarized across more than 100 participants in CIMT/bimanual training studies since 1997. This review shows that:

bimanual training may allow direct practice of functionally meaningful goals, and such practice may transfer to unpracticed goals and improve bimanual coordination;

90 hours of CIMT and bimanual training leads to greater improvements than 60 hours of the same treatments;

higher doses may be required for bimanual training;

increased dosing frequency and shaping may be needed for older children; and

combined CIMT/bimanual approaches may be useful, but require sufficient intensity.

Together these findings suggest that dosage (treatment amount and frequency), more so than ingredients, may well be the key to successful training protocols, especially for older children. Such rehabilitation efforts should be ‘child-friendly’, and as least invasive as possible, especially because these approaches may be provided throughout development. 2011. New York.

Home Based CIMT – A parent shares her journey with home based constraint induced movement therapy

Bimanual training and constraint-induced movement therapy in children with hemiplegic cerebral palsy: a randomized trial – Comparison of CIMT and Hand-Arm Intensive Bimanual Therapy (HABIT). HABIT maintains the intensity of CIMT, but children are performing tasks using both hands. Forty-two children were divided into two groups, with one group receiving CIMT and the other group receiving HABIT. Both groups demonstrated similar improvements which were maintained at six months. Greater progress towards more self-determined goals were seen in the HABIT group. Both methods lead to similar improvements in hand function. 2011. New York.

Constraint-induced movement therapy (CIMT) for young children with cerebral palsy: effects of therapeutic dosage. This study compared two groups of children, with one group receiving 3 hours of CIMT per day and the other group receiving 6 hours of CIMT per day. Therapy lasted 21 days. Overall, both groups showed comparable improvements at 1-week and 1-month following treatment. This study had a small sample size with 9 children per group. Future research should address long-term effects, enroll larger and more diverse number of participants, and determine if even smaller doses of daily CIMT will be just as effective. 2012. Alabama.